[Congressional Record Volume 149, Number 112 (Friday, July 25, 2003)]
[Senate]
[Pages S9963-S9964]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BREAUX:
  S. 1456. A bill to amend the Public Health Service Act with respect 
to mental health services for elderly individuals; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. BREAUX. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1456

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Positive Aging Act of 
     2003''.

     SEC. 2. FINDINGS; STATEMENT OF PURPOSE.

       (a) Findings.--The Congress finds that--
       (1) although, on average, \1/4\ of all patients seen in 
     primary care settings have a mental disorder, primary care 
     practitioners identify such illness in only about half of 
     these cases;
       (2) four mental disorders are among the 10 leading causes 
     of disability in the United States;
       (3) among the elderly, 10 percent have dementia and as many 
     as one quarter have significant clinical depression;
       (4) access to mental health services by the elderly is 
     compromised by health benefits coverage limits, gaps in the 
     mental health services delivery system, and shortages of 
     geriatric mental health practitioners;
       (5) the integration of medical and mental health treatment 
     provides an effective means of coordinating care, improving 
     mental health outcomes, and saving health care dollars; and
       (6) the treatment of mental disorders in older patients, 
     particularly those with other chronic diseases, can improve 
     health outcomes and the quality of life for these patients.
       (b) Statement of Purpose.--In order to address the emerging 
     crisis in the identification and treatment of mental 
     disorders among the elderly, it is the purpose of this Act 
     to--
       (1) promote models of care that integrate mental health 
     services and medical care within primary care settings; and
       (2) improve access by older adults to mental health 
     services in community-based settings.

  TITLE I--ENHANCING ACCESS TO MENTAL HEALTH SERVICES FOR THE ELDERLY

     SEC. 101. SERVICES IMPLEMENTATION PROJECTS TO SUPPORT 
                   INTEGRATION OF MENTAL HEALTH SERVICES IN 
                   PRIMARY CARE SETTINGS.

       Subpart 3 of part B of title V of the Public Health Service 
     Act (42 U.S.C. 290bb-31 et seq.) is amended--
       (1) in section 520(b)--
       (A) in paragraph (14), by striking ``and'' at the end;
       (B) in paragraph (15), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following paragraph:
       ``(16) conduct the demonstration projects specified in 
     section 520K.''; and
       (2) by adding at the end the following section:

     ``SEC. 520K. PROJECTS TO DEMONSTRATE INTEGRATION OF MENTAL 
                   HEALTH SERVICES IN PRIMARY CARE SETTINGS.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Center for Mental Health Services, shall make 
     grants to public and private nonprofit entities for evidence-
     based projects to demonstrate ways of integrating mental 
     health services for older patients into primary care 
     settings, such as health centers receiving a grant under 
     section 330 (or determined by the Secretary to meet the 
     requirements for receiving such a grant), other Federally 
     qualified health centers, primary care clinics, and private 
     practice sites.
       ``(b) Requirements.--In order to qualify for a grant under 
     this section, a project shall provide for collaborative care 
     within a primary care setting, involving psychiatrists, 
     psychologists, and other licensed mental health professionals 
     with appropriate training and experience in the treatment of 
     older adults, in which screening, assessment, and 
     intervention services are combined into an integrated service 
     delivery model, including--
       ``(1) screening services by a mental health professional 
     with at least a masters degree in an appropriate field of 
     training, supported by psychiatrists and psychologists with 
     appropriate training and experience in the treatment of older 
     adults to ensure adequate consideration of biomedical and 
     psychosocial conditions, respectively;
       ``(2) referrals for necessary prevention, intervention, 
     follow-up care, consultations, and care planning oversight 
     for mental health and other service needs, as indicated; and
       ``(3) adoption and implementation of evidence-based 
     protocols, to the extent available, for prevalent mental 
     health disorders, including depression, anxiety, behavioral 
     and psychological symptoms of dementia, psychosis, and misuse 
     of, or dependence on, alcohol or medication.
       ``(c) Considerations in Awarding Grants.--To the extent 
     feasible, the Secretary shall ensure that--
       ``(1) grants under this section are awarded to projects in 
     a variety of geographic areas, including urban and rural 
     areas; and
       ``(2) the needs of ethnically diverse at-risk populations 
     are addressed.
       ``(d) Duration.--A project may receive funding pursuant to 
     a grant under this section for a period of up to 3 years, 
     with an extension period of 2 additional years at the 
     discretion of the Secretary.
       ``(e) Application.--In order to receive a grant under this 
     section, a public or private nonprofit entity shall--
       ``(1) submit an application to the Secretary (in such form, 
     containing such information, and at such time as the 
     Secretary may specify); and
       ``(2) agree to report to the Secretary standardized 
     clinical and behavioral data necessary to evaluate patient 
     outcomes and to facilitate evaluations across participating 
     projects.
       ``(f) Evaluation.--Not later than 6 months after the close 
     of a calendar year, the Secretary shall submit to the 
     Congress a report evaluating the projects receiving awards 
     under this section for such year.
       ``(g) Authorization of Appropriations.--There are 
     authorized to be appropriated for fiscal year 2004 and each 
     fiscal year thereafter such sums as may be necessary to carry 
     out this section.''.

     SEC. 102. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH TREATMENT 
                   OUTREACH TEAMS.

       Subpart 3 of part B of title V of the Public Health Service 
     Act (42 U.S.C. 290bb-31 et seq.), as amended by section 101 
     of this Act, is further amended by adding at the end the 
     following section:

     ``SEC. 520L. GRANTS FOR COMMUNITY-BASED MENTAL HEALTH 
                   TREATMENT OUTREACH TEAMS.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Center for Mental Health Services, shall make 
     grants to public or private nonprofit entities that are 
     community-based providers of geriatric mental health 
     services, to support the establishment and maintenance by 
     such entities of multi-disciplinary geriatric mental health 
     outreach teams in community settings where older adults 
     reside or receive social services. Entities eligible for such 
     grants include--
       ``(1) mental health service providers of a State or local 
     government;
       ``(2) outpatient programs of private, nonprofit hospitals;
       ``(3) community mental health centers meeting the criteria 
     specified in section 1913(c); and
       ``(4) other community-based providers of mental health 
     services.
       ``(b) Requirements.--In order to qualify for a grant under 
     this section, an entity shall--
       ``(1) adopt and implement, for use by its mental health 
     outreach team, evidence-based intervention and treatment 
     protocols (to the extent such protocols are available) for 
     mental disorders prevalent in older adults, relying to the 
     greatest extent feasible on protocols that have been 
     developed--
       ``(A) by or under the auspices of the Secretary; or
       ``(B) by academicians with expertise in mental health and 
     aging;
       ``(2) provide screening for mental disorders, diagnostic 
     services, referrals for treatment, and case management and 
     coordination through such teams; and
       ``(3) coordinate and integrate the services provided by 
     such team with the services of social service, mental health, 
     medical, and other health care providers at the site or sites 
     where the team is based in order to--
       ``(A) improve patient outcomes; and
       ``(B) to ensure, to the maximum extent feasible, the 
     continuing independence of older adults who are residing in 
     the community.
       ``(c) Cooperative Arrangements With Sites Serving as Bases 
     for Outreach Teams.--An entity receiving a grant under this 
     section may enter into an agreement with a person operating a 
     site at which a geriatric mental health outreach team of the 
     entity is based, including--

[[Page S9964]]

       ``(1) senior centers;
       ``(2) adult day care programs;
       ``(3) assisted living facilities; and
       ``(4) recipients of grants to provide services to senior 
     citizens under the Older Americans Act, under which such 
     person provides (and is reimbursed by the entity, out of 
     funds received under the grant, for) any supportive services, 
     such as transportation and administrative support, that such 
     person provides to an outreach team of such entity.
       ``(d) Considerations in Awarding Grants.--To the extent 
     feasible, the Secretary shall ensure that--
       ``(1) grants under this section are awarded to projects in 
     a variety of geographic areas, including urban and rural 
     areas; and
       ``(2) the needs of ethnically diverse at-risk populations 
     are addressed.
       ``(e) Application.--In order to receive a grant under this 
     section, an entity shall--
       ``(1) submit an application to the Secretary (in such form, 
     containing such information, and at such time as the 
     Secretary may specify); and
       ``(2) agree to report to the Secretary standardized 
     clinical and behavioral data necessary to evaluate patient 
     outcomes and to facilitate evaluations across participating 
     projects.
       ``(f) Evaluation.--Not later than 6 months after the close 
     of a calendar year, the Secretary shall submit to the 
     Congress a report evaluating the programs receiving a grant 
     under this section for such year.
       ``(g) Authorization of Appropriations.--There are 
     authorized to be appropriated for fiscal year 2004 and each 
     fiscal year thereafter such sums as may be necessary to carry 
     out this section.''.

 TITLE II--ADMINISTRATIVE CHANGES TO STRENGTHEN PROGRAMS FOR GERIATRIC 
                         MENTAL HEALTH SERVICES

     SEC. 201. DESIGNATION OF DEPUTY DIRECTOR FOR GERIATRIC MENTAL 
                   HEALTH SERVICES IN CENTER FOR MENTAL HEALTH 
                   SERVICES.

       Section 520 of the Public Health Service Act (42 U.S.C. 
     290bb-31) is amended by redesignating subsection (c) as 
     subsection (d) and inserting after subsection (b) the 
     following:
       ``(c) Deputy Director for Geriatric Mental Health 
     Services.--The Director, after consultation with the 
     Administrator, shall designate a Deputy Director for 
     Geriatric Mental Health Services, who shall be responsible 
     for the development and implementation of initiatives of the 
     Center to address the mental health needs of older adults. 
     Such initiatives shall include--
       ``(1) research on prevention and identification of mental 
     disorders in the geriatric population;
       ``(2) innovative demonstration projects for the delivery of 
     community-based mental health services for older Americans;
       ``(3) support for the development and dissemination of 
     evidence-based practice models, including models to address 
     dependence on, and misuse of, alcohol and medication in older 
     adults; and
       ``(4) development of model training programs for mental 
     health professionals and caregivers serving older adults.''.

     SEC. 202. MEMBERSHIP OF ADVISORY COUNCIL FOR THE CENTER FOR 
                   MENTAL HEALTH SERVICES.

       Section 502(b)(3) of the Public Health Service Act (42 
     U.S.C. 290aa-1(b)(3)) is amended by adding at the end the 
     following:
       ``(C) In the case of the advisory council for the Center 
     for Mental Health Services, the members appointed pursuant to 
     subparagraphs (A) and (B) shall include representatives of 
     older Americans, their families, and geriatric mental health 
     specialists, including at least 1 physician with board 
     certification in geriatric psychiatry and at least 1 
     psychologist with appropriate training and experience in the 
     treatment of older adults.''.

     SEC. 203. PROJECTS OF NATIONAL SIGNIFICANCE TARGETING 
                   SUBSTANCE ABUSE IN OLDER ADULTS.

       Section 509(b)(2) of the Public Health Service Act (42 
     U.S.C. 290bb-2(b)(2)) is amended by inserting before the 
     period the following: ``, and to providing treatment for 
     older adults with alcohol or substance abuse or addiction, 
     including medication misuse or dependence''.

     SEC. 204. CRITERIA FOR STATE PLANS UNDER COMMUNITY MENTAL 
                   HEALTH SERVICES BLOCK GRANTS.

       (a) In General.--Section 1912(b) of the Public Health 
     Service Act (42 U.S.C. 300x-2(b)) is amended by inserting 
     after paragraph (5) the following:
       ``(6) Goals and initiatives for improving access to 
     services for older adults.--The plan--
       ``(A) specifies goals for improving access by older 
     Americans to community-based mental health services;
       ``(B) includes a plan identifying and addressing the unmet 
     needs of such individuals for mental health services; and
       ``(C) includes an inventory of the services, personnel, and 
     treatment sites available to improve the delivery of mental 
     health services to such individuals.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to State plans submitted under section 1912 of 
     the Public Health Service Act on or after the date that is 
     180 days after the date of the enactment of this Act.
                                 ______